Psychiatric Emergencies in Perinatal Women: A Retrospective Analysis

Öz

Objective: The perinatal period represents a critical juncture in a woman's life marked by profound emotional, social, and physical changes. During this phase, there is a propensity for the exacerbation of pre-existing psychiatric symptoms or the emergence of new ones. Notably, there is often an uptick in psychiatric emergencies and presentations to emergency psychiatric departments among women in the perinatal period. This study aimed to retrospectively evaluate women accessing emergency psychiatric departments during pregnancy and the postpartum period, focusing on their presenting complaints, diagnoses, clinical trajectory, and factors influencing the decision for inpatient treatment. Material and Method: A retrospective review was conducted on the records of 11,419 women aged 18 to 45 who sought care at the Psychiatric Emergency Department of Bakirkoy Prof.Dr. Mazhar Osman Research and Training Hospital Hospital between July 2015 and July 2016. Results: Among them, the records of 163 women who were either pregnant or within one year postpartum were analyzed. Of the women accessing services during the perinatal period, 46% were pregnant, while 54% were in the postpartum phase. Additionally, 38.7% of these women presented to the psychiatric department for the first time. Distress and anxiety emerged as the most common reasons for seeking help. Interestingly, no significant differences were observed between the pregnancy and postpartum periods regarding presenting complaints and clinical progression. However, the incidence of psychotic disorders was notably higher during the postpartum period compared to pregnancy. Through logistic regression analysis involving pregnancy status, presenting complaints, and diagnoses, it was determined that the nature of the presenting complaint significantly influenced the decision for inpatient treatment. Notably, scepticism, agitation, and suicidal ideation were identified as the most prevalent complaints among women who required inpatient care. Conclusion: Mental health challenges during the perinatal period not only jeopardize the well-being of the woman but also impact the health of the infant. Detecting and addressing emergent psychiatric issues during this phase are pivotal for timely intervention and preventive measures.

Anahtar Kelimeler

• pregnancy
• postpartum
• perinatal psychiatry
• emergency psychiatry

Kaynakça

1. 1. Jones I, Chandra PS, Dazzan P, Howard LM. Bipolar disorder, affective psychosis, and schizophrenia in pregnancy and the postpartum period. The Lancet 2014;384(9956):1789–99.
2. 2. Read J. Sexual problems associated with infertility, pregnancy, and ageing. Br Med J 2004;329(7465):559–61.
3. 3. Mathers C, Doris MF, Jan TB. The Global Burden of Disease: 2004 update. Vol. 13, World Health Organization 2008.
4. 4. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin: Clinical Management Guidelines for Obstetrician-Gynecologists Number 76, October 2006: postpartum hemorrhage. Vol. 108, Obstetrics and Gynecology 2006. 1039 p.
5. 5. Bennett HA, Einarson A, Taddio A, Koren G, Einarson TR. Prevalence of depression during pregnancy: systematic review. Obstetrics & Gynecology 2004;103(4):698–709.
6. 6. Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T. Perinatal depression: a systematic review of prevalence and incidence. Obstetrics & Gynecology 2005;106(5, Part 1):1071–83.
7. 7. Fisher J, Mello MC de, Patel V, Rahman A, Tran T, Holton S, et al. Prevalence and determinants of common perinatal mental disorders in women in low-and lower-middle-income countries: a systematic review. Bull World Health Organ 2012;90(2):139–49.
8. 8. Fairbrother N, Janssen P, Antony MM, Tucker E, Young AH. Perinatal anxiety disorder prevalence and incidence. J Affect Disord 2016;200:148–55.

9. 9. Viguera AC, Tondo L, Koukopoulos AE, Reginaldi D, Lepri B, Baldessarini RJ. Episodes of mood disorders in 2,252 pregnancies and postpartum periods. American Journal of Psychiatry 2011.
10. 10. Howard LM. Fertility and pregnancy in women with psychotic disorders. European Journal of Obstetrics & Gynecology and Reproductive Biology 2005;119(1):3–10.
11. 11. Kendell RE, Chalmers JC, Platz C. Epidemiology of puerperal psychoses. The British Journal of Psychiatry 1987;150(5):662–73.
12. 12. Watkins ME, Newport DJ. Psychosis in pregnancy. Obstetrics & Gynecology 2009;113(6):1349–53.
13. 13. Goodman JH, Tyer-Viola L. Detection, treatment, and referral of perinatal depression and anxiety by obstetrical providers. J Womens Health 2010;19(3):477–90.
14. 14. Vesga-Lopez O, Blanco C, Keyes K, Olfson M, Grant BF, Hasin DS. Psychiatric disorders in pregnant and postpartum women in the United States. Arch Gen Psychiatry 2008;65(7):805–15.
15. 15. Moshki M, Baloochi Beydokhti T, Cheravi K. The effect of educational intervention on prevention of postpartum depression: an application of health locus of control. J Clin Nurs 2014;23(15–16):2256–63.
16. 16. Woolhouse H, Brown S, Krastev A, Perlen S, Gunn J. Seeking help for anxiety and depression after childbirth: results of the Maternal Health Study. Arch Womens Ment Health 2009;12(2):75–83.
17. 17. Wheat S, Dschida D, Talen MR. Psychiatric emergencies. Primary Care: Clinics in Office Practice 2016;43(2):341–54.
18. 18. Wilson MP, Nordstrom K, Shah AA, Vilke GM. Psychiatric emergencies in pregnant women. Emergency Medicine Clinics 2015;33(4):841–51.
19. 19. Oates M. Perinatal psychiatric disorders: a leading cause of maternal morbidity and mortality. Br Med Bull 2003;67(1):219–29.
20. 20. Knight M, Nair M, Tuffnell D, Kenyon S, Shakespeare J, Brocklehurst P, et al. Saving Lives, Improving Mothers’ Care: Surveillance of maternal deaths in the UK 2012-14 and lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009-14. Oxuniprint 2016.
21. 21.Rallis S, Skouteris H, McCabe M, Milgrom J. The transition to motherhood: towards a broader understanding of perinatal distress. Women and Birth 2014;27(1):68–71.
22. 22.Lovibond PF, Lovibond SH. The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventory. Behaviour Research and Therapy 1995;33(3):335–43.
23. 23.Emmanuel E, St John W. Maternal distress: a concept analysis. J Adv Nurs 2010;66(9):2104–15.
24. 24. Dunkel Schetter C, Tanner L. Anxiety, depression and stress in pregnancy: implications for mothers, children, research, and practice. Curr Opin Psychiatry [Internet] 2012;25(2):141–8. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4447112&tool=pmcentrez&rendertype=abstract
25. 25. Liou SR, Wang P, Cheng CY. Longitudinal study of perinatal maternal stress, depressive symptoms and anxiety. Midwifery 2014;30(6):795–801.
26. 26. Sedov ID, Anderson NJ, Dhillon AK, Tomfohr‐Madsen LM. Insomnia symptoms during pregnancy: A meta‐analysis. J Sleep Res 2021;30(1):e13207.
27. 27. Mindell JA, Jacobson BJ. Sleep disturbances during pregnancy. Journal of Obstetric, Gynecologic, & Neonatal Nursing 2000;29(6):590–7.
28. 28. Van der Zwan JE, de Vente W, Tolvanen M, Karlsson H, Buil JM, Koot HM, et al. Longitudinal associations between sleep and anxiety during pregnancy, and the moderating effect of resilience, using parallel process latent growth curve models. Sleep Med 2017;40:63–8.
29. 29. Ortega MA, Pekarek T, Fraile-Martinez O, García-Montero C, Pekarek L, Rodriguez-Martín S, et al. A review: integrative perspectives on the features and clinical management of psychotic episodes in pregnancy. J Clin Med 2023;12(2):656.
30. 30. Rochon-Terry G, Gruneir A, Seeman M V, Ray JG, Rochon P, Dennis CL, et al. Hospitalizations and emergency department visits for psychiatric illness during and after pregnancy among women with schizophrenia. J Clin Psychiatry 2016;77(4):541–7.
31. 31. Zeller SL, Nordstrom KD, Wilson MP. The diagnosis and management of agitation. Cambridge University Press; 2017.
32. 32. Overall JE, Hollister LE, Pichot P. Major psychiatric disorders: A four-dimensional model. Arch Gen Psychiatry 1967;16(2):146–51.
33. 33. Chandra PS, Venkatasubramanian G, Thomas T. Infanticidal ideas and infanticidal behaviour in Indian women with severe postpartum psychiatric disorders. J Nerv Ment Dis 2002;190(7):457–61.
34. 34. Bharadwaj B, Endumathi R, Parial S, Chandra PS. Management of psychiatric disorders during the perinatal period. Indian J Psychiatry 2022;64(2):S414–28.
35. 35. Gressier F, Guillard V, Cazas O, Falissard B, Glangeaud-Freudenthal NMC, Sutter-Dallay AL. Risk factors for suicide attempt in pregnancy and the post-partum period in women with serious mental illnesses. J Psychiatr Res 2017;84:284–91.
36. 36. Williamson CS. Nutrition in pregnancy. Nutr Bull 2006;31(1):28–59.
37. 37. Oates M, Cantwell R. Deaths from psychiatric causes. Centre for Maternal and Child Enquiries Mission Statement 2011;132.